Provider Demographics
NPI:1417131723
Name:LANGENDORFER, RACHEL PAULINE (APRN, BC)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:PAULINE
Last Name:LANGENDORFER
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ROE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-7423
Mailing Address - Country:US
Mailing Address - Phone:864-295-2308
Mailing Address - Fax:864-295-2635
Practice Address - Street 1:15 ROE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-7423
Practice Address - Country:US
Practice Address - Phone:864-295-2308
Practice Address - Fax:864-295-2635
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA27855740Medicare PIN
SCAA2785Medicare UPIN
SCAA27859370Medicare PIN